|
07/27/2004 01:42 2e98322aE2 KWIKSERVE PAGE
<br />03
<br />Ubf 244 Wf2FVQ uta: ss arr'oa •,, • -
<br />SAN JOA,Q :(N COUNTY E O► , NTA.L ,MALTH DEPARTMENT
<br />UJlYDr6RGFtVVNA SO<'0FIta0X'Il'a►Ia X '
<br />Nti OMT0 NG PLAN v PAGE 1
<br />EACTION
<br />TYP@ OF Q L NG.W PLAN 2_'Ct•IAly(,Ap OF INFORMATION
<br />awi,
<br />PLAN'TYPE MONtTon"a L5 iDET-MCAL FOR ALL USIA AT THIS FACILITY.
<br />star.
<br />(Cheek am: ilerrt tatty) ❑ THIS PLAN. COVERS ONLY THE FOLI-OWiNt: IWr SYSTEM(S)'
<br />.'X'. FAC1L1TY INFORMA,xrON.
<br />FACILITY TOR (r4gr Use t7nry) ''a
<br />FACILI I Y NAME
<br />n
<br />FACiLTTY &TE ADDRESS �• 7 5 T*, Mne C.tTV r
<br />'•
<br />1,A. 92UXPMZN�",TESTING A.ND PREVENTIVE NIA EiY CE
<br />State 12W requires that urtinE, ptEVCnt(VC 1410inicn=M and ealibraliaa of monitoring equipment (e.g., sensors, prates line Irak deteeafra. et) br w(brmed 6e
<br />MK
<br />scobrda.ee with the cgttOrftnt ma.ukamers` trtatmdons, fir t:nntiany, whichcvct iA more *cgticnt. Suds work tttas(Uc performed by quMified personnel.
<br />MfUNv(TORING EQUTPMENT IS SERVICED ID 1. ANNUALLY ❑ 99, OTHER (SpWfy),
<br />stat,
<br />I: .' .1 UNIT'G3Et,�NG LOCAriON3
<br />This a=Ir*ring plan Trouer imelu e a Site Pim. sheswkag ZL Iteeeer2l tar& and piping layetats and the toaations whore rmmime4ri 3 Is p*f6mv4 (ix.. tocatloat (,Poach tcn.
<br />wr,
<br />lints leak defeetpr• rnoniMnng system ctln1t01 t er etc.). If you airculy have A diagram (e.g., etuTent UST Monitoring Site Phn ff6m a Mrlttii6f4lt& Systom CrftilieeNitrn
<br />Ll rdous Miamals susinamm MnLetowhich cho,ut: All uit-ed inkqtftsti^ i.olude it with tlti Tan.
<br />IV. TANS �ViQIViTO G
<br />MONTTORINCI IS PL-RPOKMGD i SIT40 THE FOLLOWIr`sG METHOD($): (Check all thatapply)
<br />Meo.
<br />C3 1. CONT(MMUS ELECTROIVIL MDNITORfNG OF TANK ANNULAR (lNTmTmAL) $PACE(S) OR SECOIQDA-RY CONfANMENT VAULT(S)
<br />SF.Cf mup,Y GQNT•A,TNMENT iSt a. DAY ❑ t,. LIQUA FIUED Q t.:.t1`IDPR PR2SS'JJ tS C3t,7t
<br />d• M%R VACt.1L"
<br />Mt:
<br />PANEL MANi FACTIJRER: 'V'nr_ gyp — t2. Re 'T Mit. MODIFA N: 4 _;- S,� M-
<br />�1i•°•
<br />_;,�
<br />LEAK SENSOR MANUFACTURER- U �. c. «i err- 2 011M Mit' MODEL tt{S) .2 C74:5 !10
<br />" �.'c R
<br />MIs.
<br />p 2. AUTOMATM TANK GAUGfl^tG (ATG) SYSTEM U.41EID TO MONITORS ❑LR VvALL TAI�iiC(si
<br />PAMM,MANUFACTURER! rwea. MODEL At:
<br />Mir•
<br />IN -TANK PRO13B MANUFACTURER: M':t. MODEL tt(S)•
<br />LEAK TEST FRFOVENC'Y: is a. CONTINUOUS ❑ b. DAILYM1011TLY © e. WFrKT.Y
<br />a�
<br />Q d. MONTtfLy D e. OTHER (specify), M21.
<br />PR.OGRAMMW TWS: ❑ a, 0.1 g.p.h. IN b. 0.2 g.p.h, ❑ c. OTHER, Mpcci y):
<br />Q 3. INYr;NTQAY RECVINCALiATION 0 a. MANUAL, PER 23 CCR ,12686 (] b. 3TATISTtCAT, PER 23 C(;K ,1A4A, l
<br />.
<br />❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR 92645
<br />TESTINO PERiOD? 0 s. 36 HOURS ❑ tt, 60 EiOURS
<br />•
<br />0 S. tHTE01UTY TE3T1NG PM B Lux 42643.4
<br />TEST FREQUENCY: a ANNUALLY ❑ b. fJIE NNiALLY (:3 c. OTHER (spee)fy};
<br />mr.
<br />6.VISUAL MONrTOIi TNG DONE: n a. DAiLY n N. WFTKEY t:te� h e..e.n►r ern.. org
<br />❑ 99. OTHER cipcc;ry).
<br />ly:k,
<br />V. ' PIPE Mt)N'xTOWNG," '
<br />MoNrrontrvt.i r,4 rkRPORmEt.) USING THE VOLLOwlNG MiTIHOD(S) (Cheek all f r "1y)
<br />saw.
<br />❑ t. CONTINUOUS ELECTROtgiC MONITORINQ OF PiPTNG SUMP(SYTRENCI4(ES) AND OTHER SECONDARY CONTAINMENT
<br />SECONDARY CONTAINNIF.NT I.C, a. DPV ❑ b. LIQUID FILLUD E3 e. UNDU PRISSSURE Ll d. UNDER VACUUM
<br />Msr.
<br />PANEL MANUPACTURER: Vf, r 4C 2. "� ��� W' MODBLtl:
<br />LEAK SENSOR MANUFAC fURi R: -- sz— c�.,�`,� er.^- - i� ca a - MX MODELit(5}: g G% - '��
<br />MD
<br />.
<br />WILLA PIPING LF.AKALARM TRJG(;ER AUTOMATIC PUMP ti.r.. TURBINE) SHUTDOWN? lR ,. YES ® b. M
<br />14341.
<br />WILL FAILi "MISCONNEC3lONI OF THE MONITORING SYSTEM TRIGGER AUTOMAXIC PUMP $FIUTDOWN. jjs. YES ❑ b. NO
<br />alar,
<br />E7 2, MECHANICAL LiNE LEAK i?ETECTOR (MLLD) THAT 9fAff NPt„Y PERFORMS 3,0 A.p,l+• LEAK =- T5 AN15 FZ3TAIC73 OR SHV A,%
<br />t)FF
<br />PRODUCT FLOW WHF,N A LEAK iS DUCTED
<br />MLLO MANUFACTUREK(21 MODEL #(n
<br />ons.
<br />❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELIS)) TVAT R.0t rrTt6t.V PIMT-ORMS 2.0 S,p.K LEAK TC -STS
<br />BLLDMANUFACTURER: __ ---, . MRD. MODEL N.
<br />Mai,
<br />PROGRAMMED LIMB INTf MTY TESTS: d a. MINIMUM MONTHLY 0,2 g p.h. ❑ b, MINIMUM ANNUAL 0.1 p p.h.
<br />MA
<br />WILL EL,LV U TP.CTION OF A VININU LEAK TRiGGER AUTOMATIC PUMP SHUTDOWN7 U a- YES ® g,140
<br />WILL ELLO FAILl)k=ISCONWECT 0M TkiOGIRR AVTOMATIC PUMP 9HUTDOWN1 ❑ A. YES Q b. N(?
<br />C7 A. F147WRRY7ESTING
<br />'T'EST nMQUENCY: i a. ANNUALLY ❑ b. EVERY 3 YEARS 0 e, OTHER (Specify) M+a
<br />® $.VISUAL MOH1TORiNG wiser: ❑ a. DAILY Cj b. WEEKLY' (3 c, Mier. MONTHLY & CAGH TWE SYSTEM VYMMTF•U-
<br />NUT.
<br />w wewlas asaw twr"I ” AR11w4.1+-m*or6r etradwtel 00-9--y acarow, W rWHu eMy Pur mss wwo1*x3)
<br />0 a. PIrtldt) IS SUCTION PIPING MEirTING ALL REQIJMMF14TS FOR EXEMP'TIO'N FROM MONITORING PER 13 MR g2636(aX3)
<br />11 T. NO PRODUCT OR REMOTE FILL Pmr. IS CDtdhIl;cno To THF. tIST(s)
<br />❑ 99. OTHER (S»eciijry a
<br />M".
<br />SJCERV4 (01fla) - 3A ` 07n+ "Ill
<br />
|